Comments
INITIAL SYMPTOMS:
Painless papule or nodule, usually on the lower extremities; Satellite nodules may appear; Usually grows 1-2 mm per year and may become pruritic; [Cohen, Ch. 179]
This chronic fungal infection of the skin usually appears on the lower extremities after a minor puncture wound. Growing slowly for months and years, the lesions become large wart-like masses. [CCDM, p. 115] The five type of lesions described are nodular, tumorous, verrucous, plaque, and cicatricial. Secondary lesions may be spread by scratching or, rarely, by dissemination through lymphatic vessels. [ID, p. 2260] The most common fungal agents are Fonsecaea pedrosoi, Cladophialophora carrionii, and Phialophora verrucosa. Barefooted, outdoor laborers are commonly affected. The lesion progresses from a papule, to a red or purplish plaque, to a scaly or verrucous plaque, and finally to a verrucous nodule. [Guerrant, p. 569-70] Ulceration is generally limited to cases with secondary bacterial infection. [PPID, p. 2926] Both chromoblastomycosis and phaeohyphomycosis are pigmented fungi. Chromoblastomycosis is a cutaneous infection. Extracutaneous infections (subcutaneous, sinuses, the brain, and other tissues) are termed phaeohyphomycosis. [Merck Manual, p. 1334] Rarely, chromoblastomycosis occurs as meningitis. [Cohen, p. 217] See "Phaeohyphomycosis."
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